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Hospital nurse managers are in the middle. Their supervisors expect that they will monitor and discipline nurses who commit errors, while also asking them to create a culture that fosters reporting of errors. Their staff nurses expect the managers to support them after errors occur. Drawing on interviews with 20 nurse managers from three tertiary care hospitals, the study identifies key exemplars that illustrate how managers monitor nursing errors. The exemplars examine how nurse managers: (1) sent mixed messages to staff nurses about incident reporting, (2) kept two sets of books for recording errors, and (3) developed routines for classifying potentially harmful errors into non-reportable categories. These exemplars highlight two tensions: the application of bureaucratic rule-based standards to professional tasks, and maintaining accountability for errors while also learning from them. We discuss how these fundamental tensions influence organizational learning and suggest theoretical and practical research questions and a conceptual framework.

In this chapter the authors focus on the role of power associated with microfoundations of organizational hybridity. They develop a framework that illuminates how key sources of power based on Buchanan and Badham (2008) and French and Raven (1959) manifest at the level of everyday work practices. Using this framework, they draw on existing studies concerning hybridity in professional organizations to illustrate how different forms of power come into play when actors guided by different logics engage in day-to-day professional work. Overall, the authors suggest that more attention to how micro-level actors use different forms of power to support, hamper, or alter different mechanisms to manage tensions among competing logics in everyday work is critical to improving our understanding about the microfoundations of institutionalism.

We bring together the institutional theory literature on institutional logics and the information systems (IS) literature that conceptualizes a relational view of affordances to explore the digital changes unfolding in the delivery of professional services. Through a qualitative inductive study of the development of an app led by a clinician manager in an Australian hospital, we investigate how multiple institutional logics shape the design of affordances when an organization develops new digital technologies for frontline professional work. Our findings show how a billing function was designed into the app by the development team over four episodes to afford potential physician users with billing usability, billing acceptability, billing authority and billing discretion. These affordances emerged as different elements of professional, state, managerial and market logics became activated, interpreted, evaluated, negotiated and designed into the digital technology through the team’s interactions with the clinician manager, a hybrid professional, during the app development process. Our findings contribute new insight to the affordance-based logics perspective by deepening understanding of the process through which multiple institutional logics play out in the design of affordances of digital technology. We also highlight the role of hybrid professionals in this digital transformation of frontline professional work.

Divestitures and other forms of organizational separation are not commonly associated with continuity and ongoing collaboration in inter-organizational relationships. Instead, separation is often equated with terminating relationships and gaining independence. Here, the authors argue that achieving separation does not require terminating relationships and that ongoing collaboration between separating entities may actually contribute to successful separation. The authors base this argument on the assertion that the objective of organizational separation is to achieve organizational autonomy for all entities involved and that separating entities can enable each other’s development of autonomy while remaining interdependent. The authors also discuss how collaborative separation may contribute to a range of benefits, as well as why it may nevertheless fail to emerge in practice. In this respect, the authors consider the relevance of ethical perspectives and emotional dynamics related to feelings of (dis)respect, (dis)trust, pride and shame. The authors conclude by discussing activities that may contribute to, and undermine, effective collaborative separation.

In this chapter, we use the job demands–resources (JD-R) model (Demerouti, Bakker, Nachreiner, & Schaufeli, 2001) and the transactional model of stress (Lazarus & Folkman, 1984) to provide a theoretical framework with which to examine information and communication technology (ICT) as both a demand and a resource. We review specific characteristics of ICT that may either increase or decrease employee stress and well-being. Specifically, we examine the extent that ICT increases accessibility of workers and access to information, the extent to which it improves communication and control over one's job and life, and the extent to which it is used to monitor employees or provide feedback. Finally, we examine the organizational, job, and individual factors that may mitigate or exacerbate the impact of ICT demands on individual outcomes.

This chapter explores how different aspects of middle manager identity relate to knowledge, research and practice. It argues that effective leadership depends more upon the person than the role.

Semi-structured interviews were conducted with 14 middle managers at a single school of healthcare in a research-intensive, chartered UK university.

The middle managers revealed both core and situated identities. Their core selves included various personality traits such as curiosity, a competitive streak, optimism, sociability and a sense of humour. Their situated selves were shaped by socialization, life history, critical people, and incidents and chance. In a symbiotic relationship with these core and situated components was a complex, tri-partite professional identity, as a healthcare professional, a higher education (HE) academic, and an education manager. All the participants greatly valued professional development and ongoing academic study.

This chapter illustrates how the best postgraduate courses develop exemplary education managers/leaders. They do this not by giving students role-specific skills but by developing their analytical and critical thinking skills. Through a process of deep learning and experience, individuals undertaking a doctorate are able to develop into reflexive and reflective practitioners who can act with personal integrity.

Little has been published about the relationships between the career background, the identity and the role of a university middle manager, and virtually nothing from the field of healthcare. The figure presented in this chapter offers a new framework for understanding the relationship between self, professional identity and role.

This chapter explores the adoption and implementation of a conflict management system (CMS) in a hospital setting. In particular, it uncovers the different motivations and challenges associated with a CMS across various stakeholders within the organization.

The chapter is based on qualitative research conducted in a large American hospital that adopted and implemented a CMS over the course of 15 months. The author conducted extensive interviews with stakeholders across the organization, including top management, union leaders, middle managers, clinicians, and frontline staff. Findings are also based on an array of observations, including stakeholder meetings and conflict management sessions.

The case study demonstrates the centrality of underexplored, generalizable, and industry-specific pressures that may lead organizations to reconsider their use of traditional dispute resolution practices and to institute a CMS. It also highlights the inherent organizational ambivalence toward the design and adoption, initiation and implementation, and routine use of a CMS and it documents the different types of outcomes delivered to various stakeholders.

The chapter provides a nuanced portrait of the antecedents to and consequences of the transformation of conflict management within one organization. It contributes to the existing body of research exploring the 30-year rise of alternative dispute resolution and CMSs in a growing proportion of firms in the United States. The use of an in-depth case-study method to examine this CMS experience offers a number of important insights, particularly regarding different stakeholder motivations and outcomes.